Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 6801087916 | MI |
N | 104100000X | Social Worker | 6801087916 | MI |
Y | 1041C0700X | Clinical Social Worker | 6801087916 | MI |
NPI | 1003239963 |
---|---|
Provider Name | Elizabeth Magana Shaw |
First Address | Detroit, MI 48201-2015 |
Second Address | Detroit, MI 48201-2015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2014 |
Last Update Date | 27/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1710286836 | (05) | MI |